Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 250. Personal incidental funds

7 AAC 43.250. Personal incidental funds

(a) Each medicaid recipient is allowed a specific monthly amount of income for personal needs, such as clothes or day-to-day incidentals. This monthly allowance may not be applied toward the recipient's cost of care. Generally, the source of income for personal needs is from OASDI benefits, veterans benefits, private income, public assistance payments, or SSI.

(1) Eligibility workers in regional offices use the amount of a recipient's income to determine

(A) initial eligibility for medicaid;

(B) amount of income or other resources which must be applied toward the recipient's cost of care;

(C) amount of income and other resources which may be retained by the recipient; and

(D) amount of the monthly incidental allowance, either $29 for grandfathered SSI cases or $25 for all other recipients;

(2) eligibility workers in regional offices shall perform an annual review of the recipient's case to determine if a recipient's total funds are within the maximum allowed for medicaid eligibility.

(b) Personal incidental items, supplies, or services furnished at the request of the recipients may be paid from their personal incidental allowance or by outside resources, such as relatives and friends.

(c) A facility may not charge a Medicaid recipient for items or services if the facility does not charge all non-Medicaid patients for those same items and services. Charges must be for direct, identifiable services or supplies furnished individual recipients. A periodic "flat" rate charge for such routine items as beverages or cigarettes is not allowed. Charges shall be made only after services are performed or items are delivered and charges may not exceed actual cost to the facility.

(d) A recipient's personal property must be clearly marked with his or her name. The facility must keep an up-to-date record of personal property separate from the facility's inventory. If items are lost, the circumstances of disappearance must be documented in the facility's records.

(e) Recipients have the right to manage their personal incidental funds unless adjudicated incompetent under state law. Recipients choosing to delegate management responsibilities should complete a written document which sets out who has been delegated this responsibility with the facility retaining a copy of that writing.

(f) When a recipient delegates management of his or her personal incidental funds to the facility, the facility must maintain a record of all money belonging to the recipient which have been received by or entrusted to the facility. The recipient must be provided receipts for all such funds accepted by the facility

(1) the facility must maintain account records for all recipients who delegate management responsibility to the facility; this record must show in detail, with supporting verification, the amount received on behalf of each individual recipient and the amount of funds disbursed; persons shopping for recipients, such as facility staff, aides, volunteers, division of social services employees, or family members, shall provide a list showing description and price of all items purchased, along with receipts for those items;

(2) funds must be deposited in a bank in a separate account, apart from any other bank account or accounts of the facility; if any interest is earned on any of these accounts, it must be credited to the applicable recipients;

(3) at least quarterly accounting of financial transactions made on the recipient's behalf must be provided without charge;

(4) the facility must notify the recipient and the regional office when a recipient's accumulated funds exceed $1500.

(g) Personal funds on deposit with the facility must be available to recipients upon request during normal banking hours. Without the recipient's permission, no funds may be withdrawn from the account of a recipient capable of making his or her own decisions.

(h) Upon discharge or transfer, the facility shall pay to a recipient 90 percent of the personal funds on deposit with the facility in his or her name. Within 30 days after discharge or transfer, the facility shall give to the recipient a final accounting of personal funds and a check for any balance on deposit.

(i) Receipts for expenditures from a recipient's personal fund, together with the recipient account record, must be retained by the facility for three years.

(j) Upon sale or other transfer of ownership interests of a facility or contract to provide nursing home services in a facility, both the transferor and transferee share joint responsibility in transferring incidental funds and records in an accurate and orderly manner.

(k) No charge may be made by the facility to a recipient for accounting or handling personal funds. The cost of accounting and handling must be included in the facility's cost of operation.

( l ) Failure to record properly the receipt and disposition of personal incidental funds constitutes grounds for suspension of provider payments to the facility.

History: Eff. 8/18/79, Register 71; readopt 8/7/96, Register 139; am 11/1/2000, Register 156

Authority: AS 47.05.010

AS 47.07.050

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.250 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.